Long-term care: Creativity, resilience strong in the face of pandemic

The situation that has unfolded at Northwood Manor in regards to COVID-19 is sure to be scary for family who have loved ones in local nursing homes.

The long-term care home in Halifax has suffered more than 40 deaths of residents since the pandemic outbreak and many staff members also tested positive for the virus.

Many long-term care facilities in the province — like the two largest ones in Pictou County — have rooms that are shared between two residents.

But Michele Lowe, managing director for Nursing Homes of Nova Scotia Association, said the size and configuration of those types of rooms were taken into account when the social distancing restrictions were implemented.

“The Public Health directives regarding social distancing and not gathering in groups of more than five took all of that into consideration, knowing full well that the physical layout of many of our nursing homes have residents that are closer than six feet apart because they share a room,” Lowe said.

“So what they have encouraged nursing homes to do is limit the amount of gatherings … and they have been incredibly creative in terms of how they have made those adjustments.”

For example, changes have been made in dining rooms to stagger eating times, moving some dining room tables and having fewer people sit at each table.

“They have been really creative and it has certainly put additional work and burden onto the staff because now in a lot of ways they are doubling up on the work they would typically do with one group. For instance, recreational staff are really trying to keep residents engaged and create as much of a normal environment as possible for them, but at the same time where they would typically bring them all together to play games and various things they are now having to do shorter time events but multiple time events so that everybody gets some level of interaction every day.”

Lowe said it is important to remember: “This is their home, and many of the images that we might see in acute care settings that are all over the TV and so on, those are sterile environments, acute care settings — long-term care is completely different. This is their home.”

Compounding the challenges faced by staff in nursing homes is trying to work around the residents with cognitive impairment and what the restrictions mean to them.

“When you stop and think the average percentage of nursing homes in this province with the average percentage of residents who have some form of dementia or cognitive impairment would be upward of 70 per cent, some have as much as 85 per cent. So that population doesn’t quite understand what those restrictions mean to them.”

What has come out loud and clear for Lowe through the COVID-19 situation locally has been the resilience and creativity of the staff and administration in dealing with the pandemic.

“There has certainly been amazing creativity.”

Handling the pandemic has not been as challenging for the newer nursing homes that have single-resident rooms — “(Staff) can do a little more one-on-one with residents in their own rooms and not worry about any contact. But for our older nursing homes, Glen Haven is certainly one of them, they’ve had to get incredibly creative. And to me, that’s the story here: the amazing work that’s being done around the province with nursing homes that have had to pivot on things that they’ve never had to do before. They are certainly accustomed to dealing with outbreak, they have them every year in terms of influenza. But the extent in which they’ve had to draw on their creativity to create as normal an environment as possible, to allow families to continue with that connection to their own loved ones through various platforms and technology that they’ve been using, and at the same time to continue to bolster morale among staff and be incredibly successful with keeping COVID out — it’s phenomenal.”

Pictou County’s two largest nursing homes — Glen Haven Manor in New Glasgow and Valley View Villa in Riverton — have not reported any instances of COVID-19 in their facilities.

Glen Haven Manor is a 202-bed facility with 20 tenants in assisted living units. There is a mixture of single and double rooms at Glen Haven with the majority being double occupancy. The double rooms are a good size which allow for more than six feet distancing between residents.

CEO Lisa M. Smith said, “Being proactive is critical. We activated our pandemic preparedness plan early and adapt and implement best practises on a regular basis.”

Bonnie Allan, board member at Valley View Villa, said keeping within the Public Health directives has not been a problem at the Villa which has two people per room. “We are one of the older facilities in the county, and we work within the confines of what we have. Infection control, keeping the residents apart from each other are all part of what you do when you have two in a room.”

Allan said she understands people are concerned about their loved ones in long-term care facilities. “But I have to commend our staff — they’re excellent.”

Although the Villa is in lockdown, staff have set up an area with a glass partition so family can see each other but still respect the distancing requirements. Phones and iPads in these areas allow families to communicate with each other.

“While doing all of the things that we have to do to prevent COVID from getting in we tried to keep the home as homelike as possible with less stress for the residents, because it is their home.”

Both of the nursing homes were well-prepared for the virus before it even hit.

When asked to what she attributes the success of the local nursing homes in remaining COVID-19 free, Lowe was quick to respond: best practices.

“There’s no question in my mind that the long-term care group is a close knit community and we value the sharing of best practices. In early January this was on our radar and nursing homes were already starting to have the discussion and pull out their pandemic plans. So that directive started long before any sort of directives came from the Department of Health or Public Health agency. And some of the nursing homes had already started to experience respiratory outbreaks with the typical flu season, so they were able to implement their restrictions early which certainly helped; but at the same time our nursing homes were out of the gate before any directive came to start to use PPEs — many of them were already using them.”

What they had not anticipated was the impact to staffing once there was declared an outbreak or a positive case with a staff member.

“We had no idea the magnitude of how that would ripple down to staffing. The Magnolia lost 70 per cent of its staff in a 24-hour period and that happened due to the tracing process. That was that one piece of information that, I believe, really helped all of the long-term care facilities in the province because immediately, when we heard that, we had not been isolating staff up until that point — in some cases, like Glen Haven as an example, because of the influenza outbreak there — to restrict the movement of the staff in the facility, they were on it.

“So that preparedness, that planning, that thoughtful sharing of what we knew and what we were learning — because things were changing by the hour … that was absolutely imperative to our success, that we share the practices and knowledge so that everybody would benefit.”

Lowe praised, “I think the leadership from the administrators has been phenomenal, and they have been, to me, the contributing factor to the success of keeping it out of more than the eighty nursing homes here in Nova Scotia.”